Cephalosporins in the treatment of meningitis.

The synthesis of new cephalosporin antibiotics has provided agents which can effectively be used to treat most of the different forms of meningitis. None of the first generation cephalosporins can be considered acceptable as agents to treat meningitis. Cefuroxime can be used to treat meningitis due to Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis in children. Agents such as cefotaxime and ceftriaxone are appropriate for neonatal meningitis due to Escherichia coli and group B streptococci, but not Listeria monocytogenes. Cefotaxime, ceftriaxone, ceftizoxime and ceftazidime have all proved effective as therapy of meningitis in children and adults when the pathogens are pneumococci, H. influenzae or N. meningitidis, but they have not been shown to yield an improved mortality or lower morbidity in spite of much greater cerebrospinal fluid (CSF) bactericidal titres. Cefotaxime, ceftizoxime, ceftriaxone and ceftazidime have been effective as therapy of meningitis due to E. coli, K. pneumoniae and Proteus species, but failures have occurred with all of the cephalosporins when used to treat meningitis due to Enterobacter spp. and Serratia marcescens. Only ceftazidime yields adequate CSF concentrations to treat meningitis due to Pseudomonas aeruginosa. Overall, the cephalosporins can now be considered a major component of the therapy of acute bacterial meningitis irrespective of the age group to be treated.